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7411 N. Keystone Ave. Suite B Indianapolis IN 46240-3375 | |
(317) 259-4616 | |
(317) 259-4672 |
Full Name | |
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Speciality | General Practice |
Location | 7411 N. Keystone Ave., Indianapolis, Indiana |
Authorized Official Name and Position | Randy Johansen (PRESIDENT) |
Authorized Official Contact | 2054038902 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3700 Cahaba Beach Rd Birmingham AL 35242-5225 Ph: (205) 403-8902 | 7411 N. Keystone Ave. Suite B Indianapolis IN 46240-3375 Ph: (317) 259-4616 |
NPI Number | 1518326248 |
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Provider Enumeration Date | 02/23/2016 |
Last Update Date | 02/23/2016 |
Identifier | Type | State | Issuer |
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1518326248 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (Indiana) | Primary |
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